Today, in Uganda, a woman can walk into a drug shop and, after training, walk out with a nine-month supply of contraceptives that she can self-inject in the privacy and comfort of her own home. For women all over the country, this is good news.
In Uganda, drug shops are often the first point of care for communities, and many of them already play a role in delivering various family planning methods, including condoms and oral contraceptives. The shops are also run by operators who have medical training, including nurses and nursing assistants. In Uganda, they were identified as key partners in helping the government meet its goal of increasing family planning uptake and use in the country, in line with global evidence. Building on lessons learned from the provision of injectable contraceptives by community health workers between March 2018 and June 2019, Uganda’s Ministry of Health (MoH) and the National Drug Authority (NDA) oversaw the provision of injectable contraceptives, without a prescription, across 20 districts spread throughout six regions of the country. Now, almost four years later, the NDA has approved the national scale-up of the provision of injectable contraceptives through drug shops.
Self-injectable contraception is an example of self-care, which MoH Senior Pharmacist Thomas Obua explains, “increases women’s agency over their own health and wellbeing.” By bringing self-injectable contraception closer to women, this approval by the NDA has the potential to increase access to, and ease of, contraception use among women in Uganda, a country where the unmet need for contraception was estimated at 30.5% in 2020.
Prior to this approval, many women had to visit clinics for their contraceptive needs, sometimes having to travel long distances. Often, they had to leave their homes unattended for hours, and queue in line along with other patients to receive contraceptives that had to be administered by health workers. Such barriers discourage many women from seeking care, which can often lead to adverse maternal outcomes. According to Dr. Obua, “self-injection could, in part, resolve the issue of discontinuation, bridge the gap for unmet need for family planning, and facilitate the utilization of contraception among vulnerable population categories.”
Drug shop operators are crucial players in ensuring the self-injection process runs smoothly. They provide women with information about various types of contraception so that they can make personal but informed choices. They also train first time self-injection users, in addition to providing them with the product. To do that, drug shop operators need appropriate training themselves and a range of materials to help them communicate the relevant information to women. “Continuous mentoring of the service providers is paramount to ensure that they perfect the knowledge and skills transfers,” says Dr. Obua. He adds that collecting feedback from the women, the consumers, is key. “Establishing feedback loops to facilitate gathering of insights from the women even as they utilize self-injectable contraceptives will aid continuity of care.”
After being trained by a drug shop operator and demonstrating competency to safely self-inject, women can now take home up to three doses of the contraceptive, each lasting three months. For nine months out of the year, they do not have to go to a drug shop or clinic or disrupt their lives in any other way for the purposes of obtaining contraception. With this product, women can prevent unintended pregnancy and practice birth spacing that is suitable for them and their families.
Salma, a 23-year old mother of three, started using injectable contraceptives in October last year after learning about it from a drug shop operator. Since then, she’s been going back every three months to receive her injection—she likes that she can afford the service, that it’s quick and that she can do it without her husband’s knowledge. Now that she’s comfortable with the product, she’s interested in learning about how she can self-inject in the privacy of her home, avoiding frequent visits to the drug shop.
Contraceptive self-injection allows women like Salma to take charge of their reproductive health care, without having to rely on health workers in clinics. Like other countries, Uganda aims to achieve the Sustainable Development Goals (SDGs) by 2030 and to transition into a middle-income country by 2040. The health sector is key to achieving these goals, and sexual and reproductive health is a key determinant of overall success. By supporting women to have more power over their sexual and reproductive health, self-injectable contraception can help improve a woman’s health and well-being as well as that of her family, her community, and the country as a whole.